Sleep in hospital

Hospitals can be bad place for sleep, both for patients and staff.

When people are sick they go to hospital for treatment and spend time there recuperating. Although sleep is important for health and recovery hospitals are often not ideal for sleep. During the night there can be noise with disturbance from other sick patients, being woken for regular checks and telephone calls and conversations amongst staff. Light exposure is also not optimal for sleep, with often too little light during the day and too much light at night.

Why is sleep important in hospital?

When people are sick intrinsic sleep regulation such as that under the control of the circadian rhythm (body clock) is not as well regulated. In addition just being admitted to hospital takes people out of their normal day-to-day routine and places them at risk of having trouble both getting to sleep and staying awake through the day. This is particularly in people in high-dependency areas in hospital such as intensive care units. People in intensive care are at risk of post intensive care syndrome (PICS) which can significantly delay their recovery and lengthen the time they spend in rehabilitation. In a ward environment acute delirium, an acute mental state characterised by disorientation, hallucinations and confusion, also prolongs people’s hospital stay and increases them to risk of other complications. It has been shown that people with poor sleep in hospital are at higher risk of the development of acute delirium.

Why are hospitals so bad for sleep?

There are a number of factors about hospitals that make sleep difficult:

Light: Hospital environments are often not designed for optimal natural lighting through the day. In addition, for staff to be able to do their work there is often light at night. This can mean that there are similar amounts of light through the night and the day which is very different to if people were outside of hospital where they get outdoor light exposure through the day and darkness at night.

Noise: Hospitals are noisy places. There are staff conversations, telephone calls, alarms beeping, people coming and going, trolleys wheeling up and down the corridor and conversations between staff or family members of other patients. Not to mention snoring or other noises from patients in shared rooms or on the same ward.

Hospital routines: Many of the work practices in hospitals are structured around what works best for hospital staff with little consideration of what works optimally for sleep. One hospital where I worked had a practice of restocking its linen and supplies at 3 am as this was when support staff had additional time even though it meant wheeling trolleys up and down hospital ward corridors in the middle of the night disturbing the sleep of patients.

Medications and treatment: Medications are an essential part of treatment and recovering in hospital, but many medications can interfere with sleep. Even if the medications themselves don’t interfere with sleep, often doses are given late at night or in the early hours of the morning disturbing sleep. For a discussion of medications and their impact on sleep, see this post.

What can be done to improve sleep in hospitals?

There are a number of factors that can be addressed to improve the sleep of patients in hospitals:

Prioritise sleep: This is the most important step as once an organisation sees sleep as a priority then other changes, which are often common sense, can flow from there.

Lighting: There are ways of managing lighting so that ward environments are dark at night and optimal for sleep. During the day as much natural light as possible can help to synchronise people’s internal circadian rhythms and reduce the risk of delirium or post intensive care syndrome. There is research going on into appropriate lighting systems for ward environments which may further improve sleep in patients and performance for healthcare workers.

Noise: There are many opportunities for reducing noise in hospital environments at night. Reducing unnecessary telephone calls, alarms, conversations and other incidental noises that are very common in hospitals. One hospital made the simple change of adding sound-reducing rubber to the wheels of hospital beds and trolleys so that they did not make as much noise when movement up and down hospital corridors occurred during the night.

Ward routines: Recognising that ward routines are often not optimal for sleep and re-evaluating and changing these to allow opportunity for sleep is important. The previous example of restocking linen and other supplies at 3 am because it suited hospital staffing is one example of where a change to ward routine can make a big difference to the hospital environment as a place for sleep.

Monitoring of patients: Not all patients need to be woken every four hours for monitoring of observations during the night. If patients are medically stable they could be left undisturbed through the night. In the future as technologies evolve wearable technologies will allow patients to require less hands-on monitoring during sleep and be monitored remotely.

A recent study combining a number of these measures (sleep education, eye masks, ear plugs and reducing noise) showed that people slept an extra 50 minutes each night.

Managing sleep in healthcare workers

As well as improving the sleep of patients it is important that the hospital environment is also optimal for healthcare workers and enables them to perform well at work and be able to sleep when off duty. There are a number of things that can be done to improve sleep in shift workers that are discussed in this blog post. Further research is being done in this area to look at factors that can improve the sleep and health of healthcare workers.

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Dr. David Cunnington is a specialist sleep physician delivering quality healthcare to clients with complex sleep problems and promoting sleep health through education, research and advocacy.
David is the co-director of Melbourne Sleep Disorders Centre, a multi-disciplinary sleep clinic for the diagnosis and treatment of sleep disorders.

We are passionate health professionals, interested about all things sleep. We provide resources and education about sleep and an online community that shares evidence-based information on sleep and wellness. Dr David Cunnington and Kris Pierce share a longstanding passion for helping people achieve better sleep and better health. Read more About Us here.

This web site is not intended as a substitute for your own independent health proffessional’s advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider within your country or place of residency with any questions you may have regarding a medical condition.